Devices and methods for reducing a dimension of openings in tissue

ABSTRACT

A clip for reducing a dimension of an opening in tissue may include a continuous member having a plurality of legs and a plurality of preformed bends connecting adjacent legs, wherein the plurality of legs form: a first group having two protrusions; a second group having two protrusions; and a third group having two protrusions, wherein each protrusion of each group includes two legs of the continuous member and a corresponding preformed bend connecting the two legs, and each protrusion of each group extends from a region adjacent a first end of the clip to a region adjacent a second end of the clip.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority to U.S. ProvisionalApplication No. 62/336,827, filed on May 16, 2016, which is incorporatedby reference herein in its entirety.

TECHNICAL FIELD

This disclosure relates to devices (e.g., clips) and methods forreducing a dimension of openings in tissue. In particular, thisdisclosure relates to implantable shape memory clips.

BACKGROUND

After undergoing surgical resection (e.g., a sleeve gastrectomy),patients may develop a post-surgical leak. Leaks may complicate recoveryand may be more severe for patients who have compromised immune systems.Leaks may cause sepsis or death, and may be costly to treat.Furthermore, some patients cannot withstand the risks of an additionalinvasive procedure.

SUMMARY

Examples of the present disclosure relate to, among other things,devices (e.g., clips) for reducing a dimension of openings in tissue.Each of the examples disclosed herein may include one or more of thefeatures described in connection with any of the other disclosedexamples.

In one example, a clip for reducing a dimension of an opening in tissuemay include a continuous member having a plurality of legs and aplurality of preformed bends connecting adjacent legs, wherein theplurality of legs form: a first group having two protrusions; a secondgroup having two protrusions; and a third group having two protrusions,wherein each protrusion of each group includes two legs of thecontinuous member and a corresponding preformed bend connecting the twolegs, and each protrusion of each group extends from a region adjacent afirst end of the clip to a region adjacent a second end of the clip.

The clip may additionally or alternatively include one or more of thefollowing features: the clip may be configured to secure a first tissueportion to a second tissue portion, with the first group configured tobe positioned adjacent the first tissue portion opposite the secondtissue portion, the second group configured to be positioned between thefirst and second tissue portions, and the third group configured to bepositioned adjacent the second tissue portion opposite the first tissueportion; the clip may include a shape memory material; relative to anaxis through a center of the clip, the preformed bends corresponding tothe first group may be positioned radially outward from the preformedbends corresponding to the third group, and the preformed bendscorresponding to the third group may be positioned radially outward fromthe preformed bends corresponding to the second group; the clip may beconfigured to transform from a compressed configuration to an expandedconfiguration; the clip may be configured to be placed in and deployedfrom a tube such that the first and third groups deploy prior to thesecond group; and the opening may be in a staple line of a patient.

In another example, a clip for reducing a dimension of an opening intissue may include a continuous member forming: a first portionconfigured to be implanted adjacent a first side of a first tissueportion; a second portion configured to be implanted adjacent a secondside of the first tissue portion and adjacent a second side of a secondtissue portion; and a third portion configured to be implanted adjacenta first side of the second tissue portion, wherein the first portion isconnected to the second portion by a first preformed bend and a secondpreformed bend, wherein the first and second preformed bends areadjacent a first end of the clip, and the third portion is connected tothe second portion by a third preformed bend and a fourth preformedbend, wherein the third and fourth preformed bends are adjacent thefirst end of the clip.

The clip may additionally or alternatively include one or more of thefollowing features: the first portion may include two protrusions, thesecond portion may include two protrusions, and the third portion mayinclude two protrusions, wherein each protrusion of each portion mayinclude two legs of the member and a corresponding preformed bendconnecting the two legs; the corresponding preformed bend of eachprotrusion may be adjacent a second end of the clip; the clip mayinclude twelve preformed bends and twelve legs, with each leg extendingbetween two preformed bends; the first and second preformed bends may beconfigured to extend over an edge of the first tissue portion, and thethird and fourth preformed bends may be configured to extend over anedge of the second tissue portion; the clip may include a shape memorymaterial; the clip may be configured to be placed in and deployed from atube such that the first and third portions deploy prior to the secondportion; and the opening may be in a staple line of a patient.

In yet another example, a method for deploying a clip may include:inserting a tube into a patient, wherein the tube includes the clip in acompressed configuration, wherein the clip includes a first portion, asecond portion, and a third portion; placing at least a portion of thetube between a first tissue portion and a second tissue portion; movingthe clip and tube relative to each other to remove the first portion ofthe clip and the third portion of the clip from the tube; allowingpreformed bends of the clip to return to a bent configuration so that atleast one preformed bend extends over an edge of the first tissueportion, and the first portion exerts radially inward pressure againstan exterior side of the first tissue portion, and at least one preformedbend extends over an edge of the second tissue portion, and the thirdportion exerts radially inward pressure against an exterior side of thesecond tissue portion; and moving the clip and tube relative to eachother to remove the second portion of the clip from the tube andposition the second portion of the clip between the first and secondtissue portions.

The method may additionally or alternatively include one or more of thefollowing features or steps: the clip may include a shape memorymaterial; the clip may include a continuous member that forms the first,second, and third portions; the first portion may include at least twoprotrusions, the second portion may include at least two protrusions,and the third portion may include at least two protrusions, the clip mayextend from a first end adjacent the edges of the first and secondtissue portions to a second end, and each of the protrusions may extendfrom a region adjacent the first end of the clip to a region adjacentthe second end of the clip; and the first tissue portion may be ananterior wall portion of a stomach, and the second tissue portion may bea posterior wall portion of the stomach.

It may be understood that both the foregoing general description and thefollowing detailed description are exemplary and explanatory only andare not restrictive of the invention, as claimed. As used herein, theterms “comprises,” “comprising,” or any other variation thereof, areintended to cover a non-exclusive inclusion, such that a process,method, article, or apparatus that comprises a list of elements does notinclude only those elements, but may include other elements notexpressly listed or inherent to such process, method, article, orapparatus. The term “exemplary” is used in the sense of “example,”rather than “ideal.”

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate examples of the presentdisclosure and together with the description, serve to explain theprinciples of the disclosure.

FIG. 1 illustrates a front view of a clip according to a first example.

FIG. 2 illustrates a side view of the clip of FIG. 1.

FIG. 3 illustrates the clip of FIG. 1 implanted over an opening in astaple line.

FIGS. 4A-4C illustrate an exemplary method for implanting the clip ofFIG.

FIG. 5 illustrates a front view of a clip according to a second example.

FIG. 6 illustrates a side view of the clip of FIG. 5.

DETAILED DESCRIPTION

The present disclosure is drawn to devices (e.g., clips) and methods forreducing a dimension of openings in tissue. The opening may be anyshape, and the dimension may be, for example, a distance across a regionof the opening, a diameter (if the opening is circular), or any othersuitable dimension of the opening. The clips described herein may beimplanted in a minimally-invasive procedure through the working channelof a catheter, endoscope, or any other elongated device (e.g., deliverydevice) with a lumen. The clips may include a shape memory material(e.g., Nitinol) to allow them to transform from a collapsed (e.g.,elongated) configuration within a delivery device to an expandedconfiguration within a patient. The clips may be used to repair a leakin a staple line, a patent foramen ovale, or any other opening intissue.

Referring to FIG. 1, a first example of a clip 10 may include acontinuous member with a plurality of preformed bends. The member maybe, for example, a wire, cable, or the like. In one example, the anglebetween the legs on either side of a preformed bend may be 90° or less.In some cases, the legs on either side of a preformed bend may extendsubstantially parallel to each other (e.g., legs 14 a and 16 a). Eachleg may be substantially straight, although there may be slight curvesor other irregularities in the member. In one example, the preformedbends may divide the member into a first group of legs 12 a-d (referredto collectively as first group 12), a second group of legs 14 a-d(referred to collectively as second group 14), and a third group of legs16 a-d (referred to collectively as third group 16), with each legextending between two preformed bends. FIGS. 1 and 2 include stipplingto better illustrate and describe the various portions of the clip 10.However, the stippling is for purposes of description and does notnecessarily represent that the different portions of the clip 10 includedifferent materials, properties, or color, although in one example thedifferent portions may include different materials, properties, orcolors.

Referring to the view of FIG. 1, the first group 12 may be positionedclosest to the viewer. The second group 14 may be positioned behind thefirst group 12, and the third group 16 may be positioned behind thesecond group 14. Referring to the side view of FIG. 2, in general, thefirst group 12 may be positioned farthest to the left, the second group14 in the middle (towards the bottom of the figure), and the third group16 farthest to the right.

Referring to FIG. 1, the legs of the first group 12 may form twoprotrusions that extend generally outward from a central axis A of theclip 10. The first protrusion may include legs 12 a and 12 b, and thesecond protrusion may include legs 12 c and 12 d. Each protrusion mayfurther extend generally in a direction from a first, proximal end 17 ofthe clip 10 towards a second, distal end 19 of the clip 10. The bend 12ab connecting the legs 12 a and 12 b may be the distal end of the firstprotrusion and may be adjacent the distal end 19 of the clip 10.Similarly, the bend 12 cd connecting the legs 12 c and 12 d may be thedistal end of the second protrusion and may be adjacent the distal end19 of the clip 10. Another preformed bend 12 bc may connect the twoprotrusions of group 12 by connecting leg 12 b to leg 12 c.

The legs of the second group 14 also may form two protrusions thatextend generally downward along axis A of the clip 10 and generally fromthe proximal end 17 towards the distal end 19. The first protrusion ofgroup 14 may include legs 14 a and 14 b, and the second protrusion mayinclude legs 14 c and 14 d. The bend 14 ab connecting the legs 14 a and14 b may be the distal end of the first protrusion and may be adjacentdistal end 19, and the bend 14 cd connecting the legs 14 c and 14 d maybe the distal end of the second protrusion and also may be adjacentdistal end 19. The bends 14 ab and 14 cd may be positioned radiallyinward (e.g., closer to axis A) from the bends 12 ab and 12 cd. Thesecond group 14 may be connected to the first group 12 by two preformedbends 13 a, 13 b adjacent proximal end 17 of the clip 10.

Finally, the legs of the third group 16 also may form two protrusionsthat extend generally outward from axis A and generally from theproximal end 17 towards the distal end 19 of the clip 10. The firstprotrusion of group 16 may include legs 16 a and 16 b, and the secondprotrusion may include legs 16 c and 16 d. The bend 16 ab connecting thelegs 16 a and 16 b may be the distal end of the first protrusion and maybe adjacent distal end 19, and the bend 16 cd connecting the legs 16 cand 16 d may be the distal end of the second protrusion and may beadjacent distal end 19. The bends 16 ab and 16 cd may be positionedradially outward (e.g., farther from axis A) from the bends 14 ab and 14cd, but radially inward from the bends 12 ab and 12 cd. The preformedbend 16 bc (behind bend 12 bc) may connect the two protrusions of group16 by connecting leg 16 b and leg 16 c. The third group 16 may beconnected to the second group 14 by two preformed bends 15 a, 15 badjacent proximal end 17 of the clip 10.

Referring to the side view of FIG. 2, leg 12 d may be visible to theleft, and leg 14 d may be visible adjacent to the leg 12 d (towards thebottom of FIG. 2). Leg 16 d may be visible on the other side of leg 14d. Legs 12 c and 16 c also may be visible in FIG. 2 due to theoverlapping wires of the clip 10. In general, in the perspectivedepicted in FIG. 2, the legs of first group 12 may be positioned towardsthe left, the legs of second group 14 may be positioned in the center,and the legs of third group 16 may be positioned towards the right.

FIG. 3 illustrates the clip 10 implanted in a patient to repair anopening in a staple line in a stomach S of patient who has undergone asleeve gastrectomy procedure. In this view, the first group 12 of legs12 a-12 d can be seen on a first side of the opening. The second group14 of legs 14 a-14 d (not shown) may be positioned within the opening,between the two stapled portions of tissue. The third group 16 of legs16 a-16 d (not shown) may be positioned on the opposite side of theopening.

FIGS. 4A-4C illustrate an exemplary method for deploying clip 10 torepair an opening 26 in tissue and place the clip 10 in the positionshown in FIG. 3. The cross-sectional views are taken along plane 4-4 ofFIG. 3. The clip 10 may be loaded into and deployed from a suitableintroducer such as, for example, an endoscope 18. In one example, theclip 10 may be loaded into a tube 20 that is positioned in a workingchannel of the endoscope 18. The clip 10 may be loaded by flipping thefirst group 12 and the second group 16 outwards and upwards relative tothe second group 14 (e.g., by bringing bends 12 ab, 12 cd, 16 ab, and 16cd from a position at the bottom of FIG. 1 to a position at the top ofFIG. 1). Radially inward force then may be applied to all of the legs tobring them towards axis A. In this compressed configuration, the clip 10may be positioned within a distal portion of tube 20, with the secondgroup 14 in a proximal position and the first group 12 and the thirdgroup 16 distal to the second group 14. A pusher 22 (shown in FIG. 4C)may be positioned within the tube 20 proximal to the second group 14.

As each portion of the clip 10 is deployed and relieved from theconfines of tube 20, the various legs and bends will resume thepreformed configuration of the clip 10 shown in FIG. 1. To deploy theclip 10 from the tube 20, the pusher 22 may be moved distally againstthe bends 14 ab and 14 cd. This motion may cause the bends 12 ab, 12 cd,16 ab, and 16 cd to protrude from the distal end of the tube 20 (FIG.4A). As the user continues to move the pusher 22 distally, the legs ofboth the first group 12 and the third group 16 may fully emerge from thetube 20, as shown in FIG. 4B. The clip 10 may be biased to its originalconfiguration, shown in FIG. 1. Accordingly, the first group 12 andthird group 16 may flip back to their original positions, causing thefirst group 12 to apply radially inward force against a first tissueportion 28 on a first side of the opening 26 and the third group 16 toapply radially inward force against a second tissue portion 30 on asecond side of the opening 26.

The first tissue portion 28 may include a first, exterior side 28 a anda second, interior side 28 b, and the second tissue portion 30 mayinclude a first, exterior side 30 a and a second, interior side 30 b.Referring to FIG. 4C, when the first group 12 is in place against afirst side 28 a of the first tissue portion 28, the preformed bends 13a, 13 b may extend around an edge of the first tissue portion 28.Similarly, when the third group 16 is in place against the first side 30a of second tissue portion 30, the preformed bends 15 a, 15 b may extendaround an edge of the second tissue portion 30. The tube 20 may then beretracted proximally to expose the second group 14 from the tube 20, nowpositioned within the opening 26 between the first and second tissueportions 28, 30, as shown in FIG. 4C. One or more tethers 24 may connectbends 14 ab and 14 cd to the distal end of the pusher 22, such that auser may pull the pusher 22 proximally to adjust the positioning of theclip 10. In an alternative example, the bends 14 ab and 14 cd mayinclude loops or openings to provide an attachment point for the tether24. Once implanted, the one or more tethers 24 may be removed from clip10.

The clip 10 may be used to treat openings in which two tissue portionslie adjacent to an opening. In one example, as shown in FIGS. 4A-4C, thetwo tissue portions may lie substantially parallel to each other.However, the clip 10 may additionally or alternatively be used to closean opening in which the two tissue portions initially lie insubstantially the same plane (e.g., tissue around an opening in a wallof an organ). In this example, the clip 10 may be deployed in the samemanner through the opening in tissue, and the radially inward force ofthe first group 12 and the third group 16 may pull the sides of theopening together such that they are pulled into a substantially parallelconfiguration and secured by the clip in a similar manner as shown inFIG. 4C.

FIG. 5 illustrates a front view of an alternative embodiment of a clip32 and FIG. 6 illustrates a left side view of clip 32. The clip 32 maybe used to treat a patent foramen ovale or any other suitable opening intissue. In one example, the clip 32 may be formed of a continuousmember, similar to clip 10, and the member may include a shape memorymaterial. A first group of lengths 34 a, 34 b, 34 c, and 34 d (referredto collectively as first group 34) may be positioned in a first cavityof an organ (e.g., in the left atrium of the heart), a second group oflengths 36 a and 36 b (referred to collectively as second group 36) maybe positioned to extend from the first cavity to a second cavity (e.g.,between two tissue portions), and a third group of lengths 38 a, 38 b,38 c, and 38 d (referred to collectively as third group 38) may bepositioned in a second cavity of an organ (e.g., in the right atrium ofthe heart).

Referring to first group 34, lengths 34 a and 34 c, beginning proximateaxis B and in the orientation of FIG. 5, may each curve slightly upwardand radially outward. Each length 34 a, 34 c may then curve downward,first in a radially outward direction and then in a radially inwarddirection, towards bends 34 ab and 34 cd, respectively, such thattogether, the lengths 34 a and 34 c form an “M” shape. A loop may beformed at bend 34 ac between lengths 34 a and 34 c for attachment of atether 44 a. Lengths 34 b and 34 d may each extend from bends 34 ab and34 cd, respectively, upwards and slightly radially inwards towards axisB.

Referring to second group 36, lengths 36 a and 36 b may connect lengths34 b and 34 d, respectively, of first group 34, to loops 38 b and 38 d,respectively, of third group 38. Each of lengths 36 a and 36 b mayextend substantially parallel to axis B.

With respect to third group 38, lengths 38 a and 38 c may form curvessimilar in shape to the lengths 34 a and 34 c of group 34. However, thelengths 38 a and 38 c may have regions with a higher curvature thanlengths 34 a and 34 c and therefore may extend radially inward to agreater degree back towards axis B. A loop may be formed at bend 38 acbetween lengths 38 a and 38 c for attachment of a tether 44 b. Lengths38 b and 38 d may form loops that connect the lengths 36 a, 36 b of thesecond group 36 to lengths 38 a, 38 c, respectively, of the third group38.

The clip 32 may be positioned in a compressed (e.g., elongated)configuration for loading into a tube. To transform the clip 32 to thecompressed configuration, first group 34 may be flipped outwards andupwards. In other words, the bends 34 ab and 34 cd may be brought from aposition at the bottom of FIG. 5 to a position at the top of FIG. 5.Then, the third group 38 may be flipped downwards and stretched, suchthat the bend 38 ac is at a proximal-most position, and loops 38 b and38 d are stretched out such that the portion of the member forming thoseloops is substantially straight. Radially inward force may then beapplied to all of the lengths of clip 32 to bring them towards axis B.In this configuration, the clip 30 may be positioned within a distalportion of tube 40, with the bend 38 ac at a proximal end and the bends34 ab and 34 cd at a distal end.

As each portion of the clip 32 is deployed and relieved from theconfines of tube 40, the various lengths will resume the preformedconfiguration shown in FIG. 5. To deploy the clip 32 from the tube 40, apusher 42 may be moved distally against the bend 38 ac. This motion maycause the bends 34 ab and 34 cd to protrude from the distal end of thetube 40, followed by lengths 34 b, 34 d and 34 a, 34 c. When lengths 34a and 34 c are about halfway complete with their exit from tube 40,lengths 36 a and 36 b begin exiting the tube 40. The user may adjust theposition of the tube 40 to ensure that the lengths 36 a and 36 b arepositioned between the two overlapping tissue portions of the patentforamen ovale. Following lengths 36 a and 36 b, the portion of themember forming loops 38 b and 38 d may begin exiting the tube 40,followed by the portion of the member forming lengths 38 a and 38 c.Finally, bend 38 ac may be pushed out of the tube 40. Tether 44 a mayconnect to the loop at bend 34 ac and tether 44 b may connect to theloop at bend 38 ac. Once the clip 32 has been deployed from the tube 40,the tethers 44 a, 44 b may be used to pull the clip 32 and adjust itsposition.

In additional or alternative examples, the clips described herein mayinclude protrusions, such as texturing or spikes, to facilitate grippingof tissue. The protrusions in some examples may damage the tissue tostimulate tissue growth around the clip, which may be useful to maintainthe implanted position of the clip. The clips may include adrug-delivery coating. In some examples, the clips may include regionsthat provide stress relief (e.g., at the preformed bends). The stressrelief regions may include a material of a different flexibility orstrength to increase the ability of the stress relief regions towithstand motions of the tissue. In one example, the member may includea zigzag shape in a stress relief region. The zigzag configuration mayallow the stress relief region to lengthen and shorten in connectionwith tissue movements.

While principles of the present disclosure are described herein withreference to illustrative examples for particular applications, itshould be understood that the disclosure is not limited thereto. Thosehaving ordinary skill in the art and access to the teachings providedherein will recognize additional modifications, applications, examples,and substitution of equivalents all fall within the scope of theembodiments described herein. Accordingly, the invention is not to beconsidered as limited by the foregoing description.

1. A clip for reducing a dimension of an opening in tissue, comprising:a continuous member having a plurality of legs and a plurality ofpreformed bends connecting adjacent legs, wherein the plurality of legsform: a first group having two protrusions; a second group having twoprotrusions; and a third group having two protrusions, wherein eachprotrusion of each group includes two legs of the continuous member anda corresponding preformed bend connecting the two legs, and eachprotrusion of each group extends from a region adjacent a first end ofthe clip to a region adjacent a second end of the clip.
 2. The clip ofclaim 1, wherein the clip is configured to secure a first tissue portionto a second tissue portion, with the first group configured to bepositioned adjacent the first tissue portion opposite the second tissueportion, the second group configured to be positioned between the firstand second tissue portions, and the third group configured to bepositioned adjacent the second tissue portion opposite the first tissueportion.
 3. The clip of claim 1, wherein the clip includes a shapememory material.
 4. The clip of claim 1, wherein, relative to an axisthrough a center of the clip, the preformed bends corresponding to thefirst group are positioned radially outward from the preformed bendscorresponding to the third group, and the preformed bends correspondingto the third group are positioned radially outward from the preformedbends corresponding to the second group.
 5. The clip of claim 1, whereinthe clip is configured to transform from a compressed configuration toan expanded configuration.
 6. The clip of claim 1, wherein the clip isconfigured to be placed in and deployed from a tube such that the firstand third groups deploy prior to the second group.
 7. The clip of claim1, wherein the opening is in a staple line of a patient.
 8. A clip forreducing a dimension of an opening in tissue, comprising: a continuousmember forming: a first portion configured to be implanted adjacent afirst side of a first tissue portion; a second portion configured to beimplanted adjacent a second side of the first tissue portion andadjacent a second side of a second tissue portion; and a third portionconfigured to be implanted adjacent a first side of the second tissueportion, wherein the first portion is connected to the second portion bya first preformed bend and a second preformed bend, wherein the firstand second preformed bends are adjacent a first end of the clip, and thethird portion is connected to the second portion by a third preformedbend and a fourth preformed bend, wherein the third and fourth preformedbends are adjacent the first end of the clip.
 9. The clip of claim 8,wherein the first portion includes two protrusions, the second portionincludes two protrusions, and the third portion includes twoprotrusions, wherein each protrusion of each portion includes two legsof the member and a corresponding preformed bend connecting the twolegs.
 10. The clip of claim 9, wherein the corresponding preformed bendof each protrusion is adjacent a second end of the clip.
 11. The clip ofclaim 8, wherein the clip includes twelve preformed bends and twelvelegs, with each leg extending between two preformed bends.
 12. The clipof claim 8, wherein the first and second preformed bends are configuredto extend over an edge of the first tissue portion, and the third andfourth preformed bends are configured to extend over an edge of thesecond tissue portion.
 13. The clip of claim 8, wherein the clipincludes a shape memory material.
 14. The clip of claim 8, wherein theclip is configured to be placed in and deployed from a tube such thatthe first and third portions deploy prior to the second portion.
 15. Theclip of claim 8, wherein the opening is in a staple line of a patient.16.-20. (canceled)
 21. A clip for reducing a dimension of an opening intissue, comprising: a first portion including: a first leg extendingfrom a first end of the first leg to a second end of the first leg; anda second leg extending from a first end of the second leg to a secondend of the second leg; wherein the second end of the first leg and thesecond end of the second leg are joined by a first preformed bend; asecond portion including: a third leg extending from a first end of thethird leg to a second end of the third leg; and a fourth leg extendingfrom a first end of the fourth leg to a second end of the fourth leg;wherein the second end of the third leg and the second end of the fourthleg are joined by a second preformed bend; and a third portionincluding: a fifth leg extending from a first end of the fifth leg to asecond end of the fifth leg; and a sixth leg extending from a first endof the sixth leg to a second end of the sixth leg; wherein the secondend of the fifth leg and the second end of the sixth leg are joined by athird preformed bend; wherein the first end of the first leg and thefirst end of the fifth leg are joined by a fourth preformed bend, andwherein the first end of the third leg and the first end of the sixthleg are joined by a fifth preformed bend.
 22. The clip of claim 21,wherein: the first portion further includes: a seventh leg extendingfrom a first end of the seventh leg to a second end of the seventh leg;and an eighth leg extending from a first end of the eighth leg to asecond end of the eighth leg; wherein the second end of the seventh legand the second end of the eighth leg are joined by a sixth preformedbend, and wherein the first end of the second leg and the first end ofthe eighth leg are joined by a seventh preformed bend; the secondportion further includes: a ninth leg extending from a first end of theninth leg to a second end of the ninth leg; and a tenth leg extendingfrom a first end of the tenth leg to a second end of the tenth leg;wherein the second end of the ninth leg and the second end of the tenthleg are joined by an eighth preformed bend, and wherein the first end ofthe tenth leg and the first end of the fourth leg are joined by a ninthpreformed bend; the third portion further includes: an eleventh legextending from a first end of the eleventh leg to a second end of theeleventh leg; and a twelfth leg extending from a first end of thetwelfth leg to a second end of the twelfth leg; wherein the second endof the eleventh leg and the second end of the twelfth leg are joined bya tenth preformed bend; wherein the first end of the seventh leg and thefirst end of the eleventh leg are joined by an eleventh preformed bend,and wherein the first end of the ninth leg and the first end of thetwelfth leg are joined by a twelfth preformed bend.
 23. The clip ofclaim 21, wherein the first portion, second portion, and third portionare formed of a single, continuous member, and the clip consistsessentially of the first portion, the second portion, and the thirdportion.
 24. The clip of claim 21, wherein the first portion isconfigured to contact a first tissue portion, and the second portion isconfigured to contact a second tissue portion.
 25. The clip of claim 24,wherein the first portion, the second portion, and the third portionhave shape memory properties such that the first tissue portion and thesecond tissue portion are drawn together by the first portion and thesecond portion.